The Presence of Bacteremia Correlates with Disease Severity in Patients with Acute Pyelonephritis Caused by Escherichia Coli

Background: Whether the presence of bacteremia or not has the implication for a severe infection in patients with acute pyelonephritis (APN) remains uncertain as yet. To investigate the relationship between the presence of bacteremia and disease severity in community-acquired APN caused by Escherichia coli (E. coli), we performed a retrospective study to compare clinical presentations, treatment response, and outcome in APN cases caused by E. coli between those with and without the presence of bacteremia. Methods: The medical records were reviewed in all cases diagnosed as community-acquired APN caused by E. coli, from January, 2003 to December, 2003, at Kaohsiung Veterans General Hospital. A total of 85 hospitalized APN patients were enrolled, all of whose blood and/or urine culture grew E. coli. Results: Among these patients, 39 patients (46%) were bacteremic and 46 (54%) were non-bacteremic. The factors that correlate with the presence of bacteremia including: increasing age, diabetes mellitus, longer duration of chills, presence of severe sepsis, more band form in neutrophils, reduced platelet count, renal function impairment, and lower level of serum albumin. Using a multivariate logistic regression analysis, lower level of serum albumin (odds ratio 0.06; 95%, CI: 0.01-0.38, P value=0.003) and presence of severe sepsis (odds ratio 4.90, 95% CI: 1.08-22.20; P value=0.039) were found to be the independent factors associated with bacteremia. In response to treatment, the bacteremic group took a longer duration to become defervescent than the non-bacteremic group (P value=0.004). Also, the bacteremic group had a greater mean duration of intravenous antibiotics administration and longer hospital stays (P value＜0.001). No mortality occurred in the study patients. The recurrence rate of urinary tract infection was similar in the two groups (P value＞0.05). Conclusion: In hospitalized APN patients caused by E. coli, the presence of bacteremia indicates a severe disease (i.e. sepsis-related) and correlated with longer duration of intravenous antibiotic therapy and hospital stays.

並列關鍵字

bacteremia ； disease severity ； E. coli ； acute pyelonephritis APN

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